chapter 57 Flashcards
The figure shows an unenhanced CT of a patient with left-sided weakness. What is the affected vessel? A. Anterior cerebral artery B. Middle cerebral arterv C. Posterior cerebral artery D. Basilar artery
a
Which of the following are recognized lacunar syndromes?
1. Pure motor stroke
2. Pure sensory stroke
3 Dysarthria-clumsy hand syndrome
4. Hemianopia Select:
A = 1,2 3.8= I, 3. C = 2, 4. D = 4 oaly. E = All
a
A man presents with left Homer’s syndrome, loss of pain and temperature sensation of the face
on the left, and loss of pain and temperature sensation of the right side of the body. In addition,
he has left-sided appendicu!?r ataxia which appears to be cerebellar.
Which blood vessel occlusions can produce this finding?
1. Basilar artery
2. Posterior inferior cerebellar artery
3. Posterior cerebral artery
4. Vertebral artery
Select: A = 1, 2, 3. B = 1, 3. C - 2. 4. D = 4 only. E = All
c
The image is from a CT of a patient who presents for evaluation of memory loss.
Which of the following findings would be expected from the location of the lesion?
1. Right hemianopia
2. Alexia
3. Anterograde amnesia
4. Agraphia
Select: A = 1. 2, 3. B = 1. 3. C = 2. 4. D - 4 only. E = All
a
Which of the following predispose to watershed infarction?
1. Cardiac arrest
2. Prolonged hypoxia
3. Cardiac surgery
4. Cardiac valvular disease
Select: A= 1,2, 3. B= 1, 3. C - 2, 4. D = 4 only. E = All
a
The figure shows a left carotid angiogram of a patient with TIA affecting the right arm and leg. A. Left ICA dissection B. Left ICA intraluminal thrombus C. Left ECA stenosis D. Left-ECA dissection
b
The image is the AP view of a left carotid angiogram of a patient with small stroke with right hemiparesis. What is shown in the angiogram? A. Dissection B. Intracranial carotid stenosis C. Moya-inoya disease D. Vasculitis
c
Which of the following are autosomal dominant causes of thromboembolic disease?
1. Activated protein C resistance
2. Protein S deficiency
3. Protein C deficiency
4. Antithrombin-III deficiency
Select: A = 1,2, 3. B = I, 3. C = 2, 4. D = 4 only. E = All
e
What is the risk of stroke in patients with primary antiphospholipid antibody syndrome without
other underlying disease?
A. Little or no increased risk of stroke
B. Moderate increase in stroke risk, although not as much as with associated autoimmune disorder
C. Marked increase in stroke risk
a
A patient presents to the ED with right hemiparesis and aphasia. The symptoms were present
upon awakening, less than an hour ago. Routine laboratory studies including coagulation studies
are normal. CT is normal Which is the best approach to treatment?
A. Intravenous t-PA
B. Intra-arterial t-PA
C. Neither
c
A 38-year-old female is admitted because of headache, vomiting, transient visual obscurations,
and she then develops seizures. MRI shows multifocal venous infaictions and MRV shows
venous thrombosis. There is a small amount of petechial biood in some of the areas of infarction.
Which is the best management option9
A. Heparin intravenously
B. Low molecular weight heparinoid
C. Warfarin
D. No anticoagulation
a
Which is the greatest risk factor for intracerebral hemorrhage? A. Aneurysm B. Anticoagulation C. Atherosclerotic disease D. Hypertension
d
What is the implication of ICH as a complication of intra-arterial thrombolytic therapy?
A. A rare complication with a good prognosis
B. A rare complication with a poor prognosis
C. A common complication with a good prognosis
D. A common complication with a poor prognosis
d
A 25-year-old man is brought to the ED having collapsed at home. lie has a right hemiparesis
with marked encephalopathy. His is known to use cocaine regularly and drug screen is positive.
Which is the diagnosis?
A, Intraparenchymal hemorrhage
B. Subarachnoid hemorrhage
C Cerebral infarction
D. Any of these
d
A man is admitted because of left hemiparesis and is found to have a right intraparenchymal
hemorrhage on CT. » he blood is mottled with minimal mass effect. There is no extension of the
blood into the ventricular or subarachnoid space. What is the most likely cause of the
hemorrhage?
A. Aneurysmal hemorrhage
B. Hypertensive hemorrhage
C. Hemorrhagic infarction
D. Venous infarction with hemorrhage
c
The image shows CT of a young man with stroke following cocaine use.
Which would be appropriate therapy for this patient?
A. Medical management
B. Open surgical drainage
C. Opening of the skull 10 allow for increased ICP
D. Ventricular drainage
a
Which imaging study is most sensitive for identification of subarachnoid blood? A. CT B. CT angiography C. MRI D MR angiography
a
A patient is found on MRI performed for hemispheric stroke to have a fusiform aneurysm of the
basilar artery. This is not in the vascular distribution to produce the presenting symptoms. Which
of the following is the main risk of this finding?
A. Subarachnoid hemorrhage
B. Intracerebral hemorrhage
C Infarction
D. Any of these
c
Which of the following is the most common complication of SAH? A. Cerebral infarction B. Hydrocephalus C. Recurrent hemorrhage D. Seizures
a
Which of the following are reasonable approaches for prevention and management of vasospasm
in patients with SAH?
1. Nimodipinc
2. Endovascular balloon dilatation
3. Maintenance of good cardiac output
4. Dehydration to minimize edema
Select: A = 1,2,3.B = 1, 3. C = 2, 4. D = 4 only. E = All
a
A patient presents with subarachnoid hemorrhage and has angiography on the second hospital
day that shows no visible aneurysm. How would you advise the patient regarding restudy?
A. Restudy is not warranted because of the negative cerebral angiogram
B. Restudy with cerebral angiography is needed 7-10 days later because of the possibility of
missing an aneurysm on early angiography
C. Restudy with MRA is needed 1 -2 weeks following the hemorrhage because of the risk of
missing an aneurysm on early angiography
b
Which of the following imaging modalities is best able to identify and characterize a cavernous malformation? A. Angiography B. CT C. MRI D. PET
c
Which of the following are potential presentations of arteriovenous malformations?
1. Seizures
2. Headaches
3. Hemorrhage
4. Infarction
Select: A = 1,2, 3. B = 1, 3. C = 2,4. D = 4 only. E - All
e
A patient with partial seizures with secondary generalization is found to have a cavernous
malformation. There is no sign of past or recent bleeding. Which is the best approach to therapy?
A. Surgical excision
B. Stereotactic radiosurgery
C. Medical therapy of the seizures
c